Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

Abstract Objective: To evaluate the effect of bilevel positive airway pressure (BiPAP) and nasal continuous positive airway pressure (NCPAP) in respiratory support after extubation in infants undergoing cardiac surgery. Methods: A total of 83 infants who underwent repair of atrial septal defect (ASD) or ventricular septal defect (VSD) after extubation were randomized to the BiPAP group (n= 42) or the NCPAP group (n= 41) between January 2020 and December 2020. The primary outcomes were the extubation failure rate and the level of PCO2 within 24 h after extubation. Results: The baseline characteristics between the two groups were similar. The introduction of BiPAP for post-extubation respiratory support did not reduce extubation failure rates compared to NCPAP (P>0.05). The PaCO2 level within 48 h was significantly lower in the BiPAP group (P<0.05). Additionally, the PaO2/FiO2 in the BiPAP group was significantly higher than that in the NCPAP group at 6h, 12h and 24h after treatment (P<0.05).There were no statistically significant differences in duaration on NIV, hospital length of stay, total hospital costs in $ and complications between the two groups (P>0.05). Conclusion: The introduction of BiPAP for post-extubation respiratory support did not reduce extubation failure rates versus NCPAP. However, BiPAP was shown to be superior to NCPAP in improving oxygenation and carbon dioxide clearance.